- Posts hospital and office charges and payments.
- Reviews explanation of benefits to resolve accounts.
- Reviews claim scrubber and resolves claim edits.
- Identifies and resolves payer issues and patient billing complaints
- Maintains payor-related items, such as EFTs and Payor IDs for 835s.
- Manages staff to oversee Explanation of Benefits are returned to staff within 1 week of request.
- Verifies insurance eligibility and authorization.
- Transmits electronic/ remittances and statements.
- Works monthly aging of PPO's, Medicare, HMO's, cash and Workers Compensation.
- Runs aging and month end reports.
- Documents detailed notes including action items taken, when appropriate.
- Responds timely and accurately to all incoming correspondence and inquiries from payers, patients and other departments.
- Performs collection actions including contacting patient, insurance companies, or third party payers.
- Reviews reports to identify denials from Medicare, PPOs, Worker Compensation, Commercial and Contracted carriers; corrects and resubmits claims using accurate ICD-9,ICD-10 and CPT codes; suggests action plans to eliminate denials in the future.
- Prepares and submits write off requests to Supervisor for denied claims that cannot be appealed.
- Elevates issues as appropriate to Supervisor.
- Participates in Performance Improvement.
- Assists with orientation and training of new employees/ volunteers, as assigned.
- Understands basic computer programs.
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